Chulalongkorn Medical Journal


Background : Gastroesophageal reflux disease (GERD) is highly prevalent,affecting 10 - 30% of the population in Western countries. InAsia, the prevalence of GERD is lower, ranging from 2.5 - 7.1%in most population-based studies. Recently, GERD has beenincreasingly encountered in clinical practices in Asian countries.Objectives : To describe the prevalence of GERD in a community-basedendoscopic examination in Thailand and to assess the relationshipbetween the endoscopic findings of esophagitis and GERDsymptoms.Materials and Method : The adults aged of at least 18 years old with uninvestigateddyspeptic symptoms or the adults aged of at least 55 years oldwith or without alarming symptoms were invited to participatevoluntary. Esophagogastroduodenoscopy (EGD) was performedin 2,488 participants from 5 different geographic regions ofThailand. A questionnaire was used to inquire the specific GERDsymptoms in all participants. The cardinal symptoms of GERDare heartburn, acid reflux and food regurgitation. Endoscopicfindings were recorded and an antral biopsy was performedand tested for Helicobacter pylori using a rapid urease test(Pronto dry). The endoscopic finding of esophagitis wascorrelated with reflux symptoms in each subject.Results : There were 2,488 participants in this community-basedendoscopic examination study, consisting of 785 men (31.6%)and 1,703 women (68.4%) with the mean ± SD age of 50.2 ± 11.9 years. There were 62.8% of participants (n = 1563) withdyspeptic symptoms whereas 37.2% of the participants(n = 925) were asymptomatic. We found typical reflux symptomsin 855 participants (34.4%); 143 of them had only reflux symptomsand 712 had overlapping symptoms of GERD and dyspepsia.Alarm symptoms, which included significant weight loss anddysphagia, were found in 13.3% (n = 330). Of 855 participantswith typical reflux symptoms, only 6.2% of them (n = 53) hadendoscopic esophagitis, whereas the group without typical refluxsymptoms, including those with asymptomatic and dyspepticparticipants (n = 1,633), endoscopic esophagitis was detectedin 4.8% (n = 78). The majority of endoscopic esophagitis patientswere of mild degree (LA class A = 93%). Participants with typicalreflux symptoms (n = 313) had H. pylori infection rate of 36.6%which was significantly lower than those participants withoutthe typical reflux symptoms (n = 686; 42%, P = 0.01) whereasH. pylori infection rate was not different in participants with orwithout endoscopic esophagitis.Conclusion : From our community–based endoscopic examination study,the prevalence of GERD using typical reflux symptoms is aboutone-third (34.4%) whereas only 6.2% of them had endoscopicesophagitis with mild esophagitis predominantly. This suggeststhat non-erosive reflux disease (NERD) is the most commoncategory of GERD among the Thai participants who experiencedtypical reflux symptoms.


Faculty of Medicine, Chulalongkorn University

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